HSHCRPToolkit€¦ · Web viewNumber of restaurants that include point of purchase labeling for...
84
Recognition Program Toolkit Developed by the Texas Council on Cardiovascular Disease and Stroke and the Cardiovascular Disease and Stroke Program at the Texas Department of State Health Services Revised June 28, 2010
Transcript of HSHCRPToolkit€¦ · Web viewNumber of restaurants that include point of purchase labeling for...
Recognition ProgramToolkit
Developed by the Texas Council on Cardiovascular Disease and Stroke and the Cardiovascular Disease and Stroke Program at the
Texas Department of State Health Services
Revised June 28, 2010
view
-tab™
tra
nspa
rent
div
ider
s5
tab
roun
d -
5506
1 -
mul
ti-co
lor
5 ta
b ro
und
- 55
062
- cl
ear
8 ta
b ro
und
- 55
063
- m
ulti-
colo
r8
tab
roun
d -
5506
4 -
clea
r5
tab
squa
re -
5506
5 -
mul
ti-co
lor
5 ta
b sq
uare
- 55
066
- cl
ear
8 ta
b sq
uare
- 55
067
- m
ulti-
colo
r8
tab
squa
re -
5506
8 -
clea
r
Qui
ck, e
asy
form
attin
g at
:w
ww
.wjin
dex
.com
2
Heart and Stroke Healthy City Recognition ProgramToolkit
Table of Contents
Page
Program Overview
2010 Assessment Schedule
Assessment Process
Sample Letter of Notification
Roles of the Local Liaison
Previous Years Scores
Template of a Typical Summary Letter
Template of a Local Public Service Announcement (PSA) for Media Release
Heart and Stroke Healthy City Assessment Forms Instructions for Completing the Assessment Community Indicator Contact Information
and Tracking Indicators and Criteria
3
5
6
7
9
11
14
16
202123
24
3
Heart and Stroke Healthy City Recognition Program Overview
Who Developed the Program? The Heart and Stroke Healthy City Recognition Program was developed in 2003 under the leadership of the Texas Council on Cardiovascular Disease and Stroke with the help of a group of public and private organizations dedicated to reducing the burden of heart disease and stroke in Texas. This planning group was brought together by the Cardiovascular Disease and Stroke Program at the Texas Department of State Health Services (DSHS) and included representatives from health, business, and school settings. The American Heart Association also played an important role in shaping the program. The program continues to evolve as experts in heart disease, stroke, and related risk factors (diabetes, obesity/poor nutrition, physical inactivity, smoking, asthma, high blood pressure, and high blood cholesterol) continue to lend their expertise and recommendations for creating a program that is science based and has practical application for community and policy change.
What Is the Purpose of the Program?The Heart and Stroke Healthy City Recognition Program recognizes cities for having environmental, and policy infrastructure and practices in place that are public health priorities for reducing cardiovascular disease and stroke. Cities involved in the program are assessed on ten priority community-based policy, systems, and environmental change indicators that are vital to reducing the burden of heart disease and stroke. Public recognition of heart and stroke healthy communities can provide reassurance to the citizens of Texas that their elected officials, community leaders, employers, schools, and health care professionals are taking action to make their communities healthier and safer places to live, work, and play.
What are the Heart and Stroke Healthy City Indicators?1) Cardiovascular Disease (CVD) and stroke ongoing public information campaigns are provided
in the community.2) Physical activity areas and opportunities are designated, safe, accessible, and promoted
throughout the city.3) Healthy food options are accessible and promoted to all members of the community.4) Public schools comply with all legislated components of a coordinated school health program
and daily physical activity and high schools offer an evidence-based health curriculum. Worksite wellness programs are in place for the majority of employees.
5) A comprehensive tobacco control program is in place that includes a 100% smoke free city smoking ordinance.
6) A plan is in place to reduce disparities in CVD and stroke.7) Training programs are in place to improve the rate of bystander Cardiopulmonary
Resuscitation (CPR) and use of Automated External Defibrillators (AED).8) Defibrillators (Manual and/or Automated External) are available to first responders and the
emergency system of care maintains a rapid response time for cardiac events.9) Stroke is treated as a medical emergency in the community and appropriate acute stroke
treatment protocols are in place.10) Healthcare sites in the community promote primary and secondary prevention of CVD and
Stroke.
What Cities are Assessed?Cities are categorized as metropolitan size (over 500,000 population), mid-size (100,000 – 499,999 population), and small-size (1 – 99,999 population) and assessed on an every other year rotation schedule.
A core of cities was selected for assessment based on their population, the presence of public health staff, and readiness to participate. Over the years, additional cities have been added to the assessment
4
schedule at their request. At this time, thirty cities are being assessed: 6 Metro Size, 10 Mid Size, and 14 Small Size.
New cities can be added to the assessment schedule at their request if they are willing to develop a community task force, identify a single point of contact to coordinate the assessment, and gather the information needed to conduct the assessment themselves.
How is the Assessment Conducted?Cardiovascular Disease and Stroke Program staff announce the beginning of an assessment cycle by sending letters to local public officials and public health staff. The staff works to identify a local liaison and provide technical assistance and support in forming a work group or task force to participate in the assessment. The assessment information is gathered and documented collaboratively by this work group. Once all of the information has been collected, a work group of the Texas Council on Cardiovascular Disease and Stroke evaluates the city’s achievement of each indicator based on the information provided. The council assigns a score to the city assessment which determines whether or not the city will be recognized. Recognition awards are presented to cities that achieve Honorable Mention, Bronze, Silver, or Gold.
Cities are presented awards during a full city council meeting by a member of the Texas Council on Cardiovascular Disease and Stroke, an American Heart Association representative, and/or DSHS staff person.
What Results Have We Seen?Since 2003, all metro size cities have received some level of recognition and 70% of all cities assessed have demonstrated an improvement in scores since their first assessment. Since 2004, five cities have received Gold level recognition (Austin, El Paso, Houston, Nacogdoches, Tyler); three have received Silver (El Paso, Houston, Waco); six have received Bronze (Austin, Dallas, Fort Worth, Lubbock, San Antonio, Waco); and seventeen have been recognized with Honorable Mention.
The Heart and Stroke Healthy City Recognition Program has stimulated interest in cities to assess their current status towards implementing policies and environmental changes that can help reduce the burden of heart disease and stroke. City leaders have acknowledged an increase in awareness of community activities around heart disease and stroke as a result of the assessment process and local business leaders are joining community efforts to achieve recognition. Due to these assessments, cities have identified gaps in their services and seek to implement appropriate evidence-based programs, policies and environmental changes to eliminate those gaps.
For More Information:Texas Department of State Health ServicesCardiovascular Disease & Stoke Program MC-1945PO Box 149347Austin, Texas 78714512-458-7111 ext. 2945E-mail - [email protected] Web - http://www.dshs.state.tx.us/wellness/default.shtm Web - www.texascvdcouncil.org
5
2010 ASSESSMENT CITY SCHEDULE
Mid Size (100,000 - 500,000 population) – 10 citiesSmall Size (1 - 99,999 population) – 3 cities
Total Number of Cities Scheduled for Assessment in 2010 = 13
MID-SIZE CITIES HEALTH SERVICE REGION (HSR)
ABILENE 2/3
AMARILLO 1
BEAUMONT 6/5S
BROWNSVILLE 11
CORPUS CHRISTI 11
LAREDO 11
LUBBOCK 1
McALLEN 11
WACO 7
WICHITA FALLS 2/3
SMALL SIZE CITIES
DENTON 2/3
LUFKIN 4/5N
TEXARKANA 4/5N
6 5/24/2023
7 5/24/2023
8 5/24/2023
The Assessment Process
The community assessment is a six part process:
1. The City is notified that the assessment is about to begin. A letter and information about the Heart and Stroke Healthy City Recognition Program is addressed and mailed to the Mayor and copied and mailed to the City Manager, local Public Health Director, and Regional Public Health Director to let them know the assessment is going to take place. If a local liaison has been identified, the letter will state the contact information for the liaison.
2. A local liaison and local stakeholders are identified by the city. City leaders, or the local liaison if one has been identified, are asked to complete a Community Indicator Contact Information and Tracking form that identifies the best contacts for obtaining information about each of the ten indicators.
3. Data collection begins. Cardiovascular Disease and Stroke Program staff work with the local liaison and provide technical assistance and support in forming a work group or task force to participate in the assessment. The assessment information is gathered and documented collaboratively by this work group. Cardiovascular Disease and Stroke Program staff will also provide technical assistance regarding locating information, meeting indicator criteria, and implementing evidence-based programs and policies to improve city scores.
4. Assessments are scored. Using the collected information, the Council’s Community Policy and Environmental Change Committee will score each assessment to determine how well the city has met the criteria. Scores are presented to the full Council and awards are announced.
5. Assessment results are provided to the city. City leaders and participating community members will receive a summary of their assessment, their final score, notice of an award, and recommendations for meeting indicator criteria for future assessments. Ongoing technical assistance and support is provided by Cardiovascular Disease and Stroke Program staff as cities work to implement evidence-based strategies to improve their scores and create healthier communities.
6. Awards are presented. Recognized cities will be asked to schedule an award presentation to be presented by a member of the Council at a city council meeting. Cardiovascular Disease and Stroke Program staff will submit a statewide press release for publication announcing the completion of the assessment and award results. A template for a local press release is provided for communities receiving awards. Communities are encouraged to seek local media coverage of their accomplishments and bring attention to heart disease and stroke issues.
9 5/24/2023
[Date] -----SAMPLE LETTER OF NOTIFICATION----
The Honorable MayorCity of XXXP.O. Box 1234City, TX 71111
Dear Mayor XXX:
We are pleased to inform you that the City of XXX, along with thirteen other Texas cities, will be included in the 2010 assessment process for the Heart and Stroke Healthy City Recognition Program from July to August 2010. This program is administered by the Texas Council on Cardiovascular Disease and Stroke to recognize cities in Texas for their achievements in creating healthy communities.
This state-wide program recognizes Texas cities for having in place a set of ten evidence-based, community indicators that are known to be important in reducing the burden of heart disease and stroke, which are the number one and number three killers of men and women in Texas and the United States.
XXX from the local health department/City/local hospital has volunteered to be our local liaison. He/she will form a work group of appropriate local stakeholders to participate in the city assessment process. The staff of the Cardiovascular Disease and Stroke Program at the Department of State Health Services (DSHS) will provide technical assistance and support to the City team. In the last assessment (2007), City earned a XXX recognition level!
A copy of the 2010 indicators and their criteria is attached. I am also providing a report from the Centers for Disease Control and Prevention that describes how you and other local officials can participate in this important work. To support this effort to get the City of XXX recognized and to ensure critical city members are participating, please contact Local Liaison at [email protected] or at telephone number.
The Texas Council on Cardiovascular Disease and Stroke will review and score all city assessments in early 2011. Cities that achieve a recognition level of Bronze, Silver, or Gold, will be recognized at the state and local levels, including a presentation of the award recognition at a city council meeting. All cities will be notified about the results of the assessment and offered ongoing technical assistance to implement improvements and create a healthier community.
10 5/24/2023
If you have any questions, please contact Mike Messinger at [email protected] or 512-458-7111, ext 3554. Thank you for your support in making your city a heart and stroke healthy city.
Sincerely,
Thomas E. Tenner, Jr., Ph.D.Chair, Texas Council on Cardiovascular Disease and Stroke
Attachments: Program Overview, Heart and Stroke Healthy City Indicators/Criteria, Chart of Previous Year’s Scores, 2007 Summary Letter,Moving into Action for Local Officials,Texas Plan to Reduce Cardiovascular Disease and Stroke (2008)
Cc: City ManagerDirector of Local Health Department Medical Director of DSHS Health Service Region Program Manager/Supervisor of Health Promotion/Chronic Disease at Local Health
Department or Local HospitalLocal Liaison
---- SAMPLE LETTER OF NOTIFICATION ----
11 5/24/2023
Roles of a Local Liaison
1. LIAISON: Acts as a local liaison between the Cardiovascular Disease and Stroke Program at the Department of State Health Services (DSHS) and the city.
2. IDENTIFIER: Liaison identifies local individuals, work group(s), or coalition(s) that work on awareness, prevention, and quality of care, of heart disease, stroke, or modifiable risk factors. Risk factors may include diabetes, obesity/poor nutrition, physical inactivity, smoking, asthma, high blood pressure, and high blood cholesterol. Liaison approaches existing groups to see if they are interested in participating in the assessment and/or working to make progress on an indicator.
3. GROUP CONVENER: Liaison develops a work group that consists of individuals from various, community-wide public and private health sites, businesses, schools, and city departments. Work group consists of approximately 10 participants that will be assisting in gathering information.
4. NEGOTIATOR: Depending on the participant’s area of expertise, liaison obtains commitment from participants to collect information about a particular indicator and document the information requested in the Heart and Stroke Healthy City indicator form. For example, the indicator on physical activity and programs that are available in the city might be addressed by the city parks and recreation department. The representative from Parks and Recreation would take the lead on collecting and documenting the information needed for that indicator.
5. COLLECTOR: Liaison collects indicator information from all participants and prepares one packet (for example a binder or folder) with all of the documentation for each indicator. The Liaison may wish to have multiple meetings with the group to discuss progress and review the information collected to be sure it reflects what is happening in the community. Once the liaison and the group are satisfied that the packet is complete, the liaison mails the packet to DSHS for scoring.
Benefits for the CityWhen this process is followed, the assessment is much more likely to be an accurate reflection of what the city has in place. This generally results in a higher score. Also, by bringing together stakeholders that have an interest in the various indicator areas, the group becomes motivated to implement new policies and create system and environmental changes that support healthy behaviors.
Benefits to the LiaisonThe liaison will develop closer relationships with the state health department and with members of the community. Before, during, and after the assessment, the liaison will receive and have the opportunity to forward emails and notices to participants and community leaders regarding national or state conferences, trainings, funding opportunities, updates, or other pertinent information. The liaison becomes a critical part of a network connecting the community with state and national information and opportunities. The liaison also has the opportunity to practice and develop leadership strategies that will benefit their organization and the community.
12 5/24/2023
Our commitment to the liaisonCardiovascular Disease and Stroke Program staff is committed to working with the liaison and the community in whatever way is needed. Our technical assistance can include:
1. Attending an assessment kick-off meeting to introduce the program to a newly formed work group.
2. Discuss the information and documentation that is being collected and provide recommendations and ideas.
3. Share successes and challenges that other cities have faced4. Make phone calls and conduct Internet searches to uncover assessment information5. Answer questions about the assessment forms or requested data6. Pass on state and national information that might be of interest to the community partners
NOTE: Although the local health department generally takes on this role, the local liaison does not have to be from the city health department. Any member of the community working in heart disease and stroke or related risk factors with a desire to lead the effort can participate as the liaison.
13 5/24/2023
2003 - 2009 Scores and Recognition for Metropolitan-Size Cities
CITY RECOGNITION LEVELAustin GOLD (2009, 96/100 + 3 bonus points), GOLD (2007), BRONZE (2005)
Dallas Honorable Mention (2009, 64.5/100), Honorable Mention (2005), Recognized (2003)
El Paso GOLD (2009, 92.5/100), SILVER (2007), GOLD (2005)
Fort Worth SILVER (2009, 80/100), Honorable Mention (2007), BRONZE (2005)
Houston GOLD (2009, 92.5/100), GOLD (2007), SILVER (2005)
San Antonio BRONZE (2009, 75.5/100), BRONZE (2005)
14 5/24/2023
2004, 2006, and 2008 Scores for Mid-Size Cities
2004, 2006, and 2008 Scores for Mid-Size Cities
32
2422
18 18
0
22 22
14
24
20
30
0
24
34
0
5
10
15
20
25
30
35
40
Abilene Amarillo Beaumont Brownsville Corpus Christi
Scor
e O
ut o
f 40
2004
2006
2008
CITY RECOGNITION LEVELAbilene Honorable Mention (2004)Amarillo Honorable Mention (2008)Corpus Christi Honorable Mention (2008)
2004, 2006, and 2008 Scores for Mid-Size Cities
12
2224
3632
22
34
16
38
14
2826 26
34
30
0
5
10
15
20
25
30
35
40
Laredo Lubbock McAllen Waco Wichita Falls
Scor
e O
ut o
f 40
2004
20062008
CITY RECOGNITION LEVELLubbock BRONZE (2006)Waco Honorable Mention (2008), SILVER (2006), SILVER (2004)Wichita Falls Honorable Mention (2008), Honorable Mention (2004)
15 5/24/2023
2004, 2006, 2008 and 2009 Scores for Small-Size Cities
2004, 2006, and 2008 Scores for Small-Size Cities
0
18
28
18
0 0
26
32
26
36
2422 22
26
36
32
0
26
30
0
22
0
5
10
15
20
25
30
35
40
Bryan Denton Galveston Georgetown Harlingen Huntsville Longview
Scor
e O
ut o
f 40
2004
2006
2008
CITY RECOGNITION LEVELBryan Honorable Mention (2008), Honorable Mention (2003)Denton Honorable Mention (2008)Galveston Honorable Mention (2006)Harlingen Honorable Mention (2008)Huntsville Honorable Mention (2009, 61/100)
2004, 2006, and 2008 Scores for Small-Size Cities
26
0
26
0 0
30
0
2018
3026
30 3026
24 24
40
2832
40
00
5
10
15
20
25
30
35
40
45
Marshall Midland Nacogdoches Odessa Temple Tyler Victoria
Scor
e O
ut o
f 40
2004
2006
2008
CITY RECOGNITION LEVELNacogdoches GOLD (2008)Temple Honorable Mention (2008), Honorable Mention (2006)Tyler GOLD (2008), Honorable Mention (2006), Honorable Mention (2004)Victoria Honorable Mention (2009, 60.5/100)
16 5/24/2023
Date
MayorAddressHealthyheart, TX
Dear Mayor:
Recognition Levels:Gold Level - Score of 90-100Silver Level - Score of 80-89 Bronze Level - Score of 70-79 Honorable Mention - Score of 60-69
At the completion of the assessment, XXX achieved a score of # meeting a recognition level of ???.
The Texas Council on Cardiovascular Disease and Stroke congratulates your city on receiving ??? recognition. The program will contact you to make arrangements to receive the award plaque. The Cardiovascular Disease and Stroke Program is also available to assist in developing plans to increase your recognition level in the future. The program can be reached at 512-458-7200 or via email [email protected] to assist you in developing a more Heart and Stroke Healthy City!
Thomas E. Tenner, Jr., Ph.DChair, Texas Council on Cardiovascular Disease and Stroke
17 5/24/2023
City: XXX [SAMPLE]
Cardiovascular and Stroke Indicators
All Criteria Met
Criteria Partially Met
Criteria Not Met
1. Cardiovascular disease and stroke media campaigns are provided in the community (television, radio, newspapers). 42. Physical activity areas are designated, safe, accessible and promoted. 43. Healthy food options are accessible and promoted. 44. Public schools (grades K-6) comply with all legislated components of a coordinated school health program and daily physical activity. (TEA approved program included)
4
5. Moderate to strong city smoking ordinances are in place. 26. CPR classes are available. 47. A plan is in place to reduce disparities in CVD and Stroke. A specific group addressing African Americans is present in the task force.
4
8. Defibrillators (Manual and/or Automated External) are available. City maintains a 5-minute average response time. 49. Stroke is treated as a medical emergency in the community and appropriate acute stroke treatment protocols are in place. 410. Health Sites in the Community promote Primary and Secondary Prevention of CVD and Stroke. 4Total of Indicators: 36 2Summary Score 38
Summary and Recommendations:
Overall XXX met enough criteria to warrant a recognition level of Silver. However, there is one Indicator in which the criteria were only partially met. XXX lacked a strong city smoking ordinance covering all public and worksite locations.
Recommendation: Contact your Regional Tobacco Specialist at your Regional Department of Health or the American Cancer Society to find tools/suggestions on how to gain local support to strengthen your smoking ordinance. The Centers for Disease Prevention and Control has information and resources regarding tobacco control at http://www.cdc.gov/tobacco/.
For more information on resources that are available to assist you in identifying and developing appropriate activities to meet all of the Heart and Stroke Healthy City indicators and increase your recognition level in the Heart and Stroke Healthy City Recognition Program, you may contact the Cardiovascular Disease and Stroke Program at (512) 458-7200, or email at [email protected] or by visiting our website at http://www.dshs.state.tx.us/wellness/default.shtm.
18 5/24/2023
SAMPLE PRESS RELEASE For Local Release
Texas Council on Cardiovascular Disease and Stroke________________________________________________________________________
Texas Council on Cardiovascular Disease and Stroke Recognizes XXX forPreventing and Controlling Heart Disease and Stroke
www.texascvdcouncil.org
The Texas Council on Cardiovascular Disease and Stroke recently recognized XXX with a XXX Level award for promoting heart and brain health.
The council’s Texas Heart and Stroke Healthy City Recognition Program honors cities that advance identified best practices for preventing and controlling heart disease and stroke. “This program helps bring into focus those cities that raise the bar in cardiovascular health,” said Tom Tenner, PhD, Vice-Chair of the Texas Council on Cardiovascular Disease and Stroke. “XXX is being acknowledged at the XXX Level based on an assessment of implementation of recognized best practices in policies and environmental changes. XXX met XXX and partially met XXX of the 10 indicators. We encourage greater participation in existing programs and implementation of new initiatives for the prevention and treatment of CVD and stroke in the years ahead.”
A set of ten indicators are used to determine recognition of a Heart and Stroke Healthy City. Environmental indicators include offering physical activity areas, healthy eating options, defibrillators and CPR classes in the community. Policy indicators consist of implementation of moderate to strong smoke-free ordinances in worksites, restaurants, and day care centers; an EMS system with emergency treatment protocols and priority response times to calls for heart attacks or strokes; and recognized guidelines for the care and treatment of heart attack and stroke in hospitals.
The Texas Council on Cardiovascular Disease and Stroke was created in 1999 by the Texas Legislature and appointed by the Governor. The mission of the council is to educate, inform and facilitate action among Texans to reduce the human and financial toll of cardiovascular disease and stroke.Council staff can be contacted at:
Cardiovascular Health and Wellness Program MC 1945, Health Promotion Unit Texas Department of State Health Services PO Box 149347Austin, Texas 78714-9347Phone: (512) 458-7200E-mail: [email protected]
19 5/24/2023
CARDIOVASCULAR FACTS:
Heart disease and stroke killed almost 51,114 Texans in 2006, while 6.5 percent of the adult population reported having been told they had cardiovascular disease in 2009.
Over $11 billion of hospital charges for ischemic heart disease, hemorrhagic stroke, ischemic stroke and congestive heart failure were reported for 2008.
Risks that contribute to developing heart disease or having a stroke are smoking, physical inactivity, high blood pressure, high blood cholesterol, diabetes and obesity.
Overweight and obesity rates in Texas have been climbing over the past decade, with almost 67 percent of Texans being overweight or obese in 2009.
Management of risk factors, including working with health care providers to improve the level of care provided to the patient, is crucial to preventing a heart attack or stroke from occurring or recurring.
(News media: for more information contact XXX).
20 5/24/2023
SAMPLE PRESS RELEASE For Statewide Release________________________________________________________________________
Texas Council on Cardiovascular Disease and Stroke Recognizes XXX Cities for Preventing and Controlling Heart Disease and Stroke
www.texascvdcouncil.org
The Texas Council on Cardiovascular Disease and Stroke recently recognized the following cities for their promotion of heart and brain health: XXX, XXX, XXX and XXX.
The council’s Texas Heart and Stroke Healthy City Recognition Program honors cities that advance recognized best practices for preventing and controlling heart disease and stroke.
“This program helps bring into focus those cities that raise the bar in cardiovascular health,” said Tom Tenner, PhD, Vice-Chair of the Texas Council on Cardiovascular Disease and Stroke. “The recognized cities were found to be best prepared, based on an assessment of recognized best practices in policies and environmental changes. We hope to add more to the list of Gold Level award winners, using XXX as a model city. We encourage greater participation in existing programs and more development of new initiatives for the prevention and treatment of cardiovascular disease and stroke in the years ahead.”
More information about the Heart and Stroke Healthy City Recognition Program can be found on the Texas Department of State Health Services web site at www.texascvdcouncil.org, or by contacting the Cardiovascular Disease and Stroke Program by phone at 512-458-7200 or email at [email protected].
The following cities were recognized at the Gold, Silver, Bronze, or Honorable Mention Level:
Gold Level
Silver Level
Bronze Level
Honorable Mention
A set of ten indicators are used to determine recognition as a Heart and Stroke Healthy City. Environmental indicators include offering physical activity areas, healthy eating options, defibrillators and CPR classes in the community. Policy indicators consist of implementation of moderate to strong smoke-free ordinances in worksites, restaurants, and day care centers; an EMS system with emergency treatment protocols and priority response times to calls for heart attacks or strokes; and recognized guidelines for the care and treatment of heart attack and stroke in hospitals.
The mission of the Texas Council on Cardiovascular Disease and Stroke is to educate, inform and facilitate action among Texans to reduce the human and financial toll of cardiovascular disease and stroke. Created in 1999 by the 76th Texas Legislature, the fifteen-member council consists of eleven governor-appointed, senate-approved voting members and four state-agency appointed non-voting members.
CARDIOVASCULAR FACTS:
21 5/24/2023
Heart disease and stroke killed almost 51,114 Texans in 2006, while 6.5 percent of the adult population reported having been told they had cardiovascular disease in 2009.
Over $11 billion of hospital charges for ischemic heart disease, hemorrhagic stroke, ischemic stroke and congestive heart failure were reported for 2008.
Risks that contribute to developing heart disease or having a stroke are smoking, physical inactivity, high blood pressure, high blood cholesterol, diabetes and obesity.
Overweight and obesity rates in Texas have been climbing over the past decade, with almost 67 percent of Texans being overweight or obese in 2009.
Management of risk factors, including working with health care providers to improve the level of care provided to the patient, is crucial to preventing a heart attack or stroke from occurring or recurring.
(News media: for more information contact XXX).
22 5/24/2023
Recognition Program Assessment Forms
Thank you for participating in the Heart and Stroke Healthy City Recognition Program! The following 10 Indicators have been identified by a group of Texas stakeholders with expertise in heart disease and stroke prevention as priority, evidence-based approaches for primary and secondary prevention of cardiovascular disease and stroke and providing quality care. When these Indicators and their respective criteria are present, they indicate a city is taking a proactive approach in creating environments, systems, and policies that promote healthy lifestyles and quality patient care.
Each Indicator is loaded with information about resources for helping communities establish policies, create environments, and implement systems changes to promote healthy lifestyles and provide quality patient care. A listing and links to these resources can be found on the DSHS website at http://www.dshs.state.tx.us/wellness/default.shtm
23 5/24/2023
Completing the Assessment
To participate in the Heart and Stroke Healthy City Recognition Program, a city will complete the following steps:
1. Identify a local liaison that will coordinate the community assessment among community stakeholders, collect and compile the assessment data with the help of community stakeholders, and submit the assessment data to the Department of State Health Services.
2. Identify a group of community stakeholders that are most likely to have the information requested in the assessment and invite them to participate. This can be an existing or new coalition, work group, or task force. A community contact form has been included for documenting community participant contact information and tracking when participant information has been received.
3. Complete the attached assessment forms for all 10 indicators. The forms will be made available in a Microsoft Word document and as 10 separate Word documents for distributing to key stakeholders.
To complete the forms electronically, the form will need to be opened in the locked mode. Directions for locking and unlocking boxes are: View/Toolbars/Forms – then click on the icon of the lock to lock and unlock the form. In the locked mode, click on a box when the answer is positive, leave blank when the answer is negative. Provide narrative descriptions in text fields where indicated. Additional descriptions, explanations, examples, or information can be provided in the text fields labeled ‘Additional Descriptions’.
Stakeholders completing the assessment forms may also be asked to submit supplementary documents to serve as evidence that criteria have been met, for example a sample dining guide will be submitted with Indicator # 3. There are no page limits or requirements. However, lack of any supplemental materials or a description of activities could affect your score if the Texas Council Cardiovascular Disease and Stroke does not have enough information to make a score determination.
4. Submit the completed assessment by:a. Compiling all completed electronic assessment forms and e-mailing them to Mike
Messinger at [email protected]; orb. Printing all completed assessment forms and submitting them in hard copy with
supplementary documentation attached. Mail hard copies to:
Mike MessingerTexas Department of State Health Services Cardiovascular Health and Wellness Program, MC 19451100 W 49th StreetAustin, TX 78756
If you experience any problems using the forms, contact Mike Messinger at [email protected] or 512-458-7111 ext. 3554.
24 5/24/2023
The CVD Council at the Department of State Health Services will score the assessments and approve recognition awards. Every city participating in the program will be notified of their score and recognition level. All awards (Gold, Silver, Bronze, and Honorable Mention) will be recognized with a plaque and all stakeholders participating in the assessment process will be provided with a certificate of participation. Cities receiving a recognition level of Gold, Silver, or Bronze will be presented with their award at a city counsel meeting.
Cities that do not score well will receive ongoing technical assistance and support for making improvements in areas of weakness. It is our commitment that every city participating in the Heart and Stroke Healthy City Recognition Program is recognized as a heart and stroke healthy place for Texans to live, work, and play.
25 5/24/2023
Community Indicator Contact Information and Tracking
List the contact information for each community participant contributing information for the assessment. Include as many stakeholders as you would like under each indicator (add more rows). The local liaison may wish to use this as a tool for tracking when assessment information has been received.
Contact Person Organization Phone E-mail Final Info Received
1. Ongoing Public Information Campaigns
2. Physical Activity is Promoted
3. Access to Healthy Food
4. Healthy Schools-Healthy Worksites
5. Comprehensive Tobacco Control
6. Addressing Disparities
7. Bystander CPR and AED Use
8. Cardiac Event Response
26 5/24/2023
9. Stroke Event Response
10. Healthcare Quality
27 5/24/2023
Indicator 1ONGOING PUBLIC INFORMATION CAMPAIGNS
Cardiovascular disease and stroke ongoing public information campaigns are provided in the community.
Why is this important?The following two criteria are evidence-based strategies for creating an environment in which citizens are continually informed about the need for adopting healthy behaviors and the opportunities available in their community for taking action. Throughout all of these indicators, community refers to the city and populations within the city including faith-based organizations, senior and youth organizations, social organizations, schools, health care sites, city government, and public and private businesses/employers.
A. The use of mass media campaigns as part of multi-component, community-wide campaigns are effective in reducing tobacco use and promoting physical activity. Mass media refers to public communication intended to reach very large audiences such as an entire city, county, region, state, or the nation.
B. Multi-component, community-wide campaigns involve collaborating with and reaching audiences through a variety of community sectors such as worksites, schools, healthcare settings, and community social settings. Multi-component programs can include the use of media and public information campaigns, one-on-one counseling, health screenings, health care practitioner recommendations, environmental support systems, and socioeconomic incentives among others.
CRITERIA:
A. The community has developed and aired its own, or used pre-existing, mass media campaign(s) through sources such as television, radio, or newspapers on issues such as disease burden, healthy lifestyle behaviors, risk factors, or prevention measures for cardiovascular health and/or stroke in the past 12 months.
Indicate below how your community is meeting this criterion:Include all mass media campaigns that have occurred in the past yearCampaign Name, Topic, URL if described on website
Radio Spot- Station, Dates and Times
Television Spot – Station, Dates and Times
Newspaper Article – Paper and Dates
Billboards – Number and Locations
Other -
For all campaigns, attach copies of campaign materials or provide URL of website where campaign can be found. If not available, describe the campaign briefly:
Topics that will be accepted include: physical activity, nutrition, overweight and obesity, tobacco, blood pressure, cholesterol, diabetes, signs and symptoms of heart attack, signs and symptoms of stroke, asthma and calling 9-1-1.
28 5/24/2023
Additional descriptions:
B. The community has implemented an ongoing, multi-component, community-wide, highly visible, integrated campaign involving many sectors of the community.
Please check all appropriate boxes and indicate below how your community is meeting this criterion:Include all sectors of the community involved in community-wide campaignsCampaign name, topic, URL if described on website
Worksite – number of sites
Schools – number of campuses and grade levels
Health care sites – number of sites, services offered
Community based org – number of sites and number of events
Other -
Community base organizations include social organizations, faith based organizations, and others not fitting into one of the other categories.
Messages target large audiences through: Mass media (newspaper, radio, television, billboards – see Criterion A) Posters in public areas (bus stops, movie theaters, etc) Direct mail Newsletters distributed widely Electronic media: Describe
Components include: Counseling/physician recommendations Reminders/prompts Health screenings Health risk appraisals Public education Other: Describe:
Additional descriptions:
Examples of CampaignsAmerican Heart Association: Community: “Go Red for Women”, “Search Your Heart/Conozca Su Corazon”, “Power to End Stroke”; School: “Hoops for Heart”, “Jump Rope for Heart”; Worksite: “Start!”NHLBI “The Heart Truth for Women”State programs: “Texas Round-Up”, “GetFitTexas!”, “Fit Kids”“5-A-Day” CampaignLocal physician/health reporter featured on radio, TV, or newspaper talking about chronic disease, prevention, risk factorsUse of “FAST”, “Suddens”, or “Give Me 5” to educate about stroke signs and symptomsAmerican Cancer Society’s “Great American Smoke Out”Centers for Disease Control & Prevention’s “WISEWOMAN”
Resources/References:29 5/24/2023
Guide to Community Preventative Services: Systematic Reviews and Evidence-based Recommendations, U.S. Task Force on Community Preventive Services www.thecommunityguide.orgAHA Guide to Improving Cardiovascular Health at the Community Level, American Heart Association www.circulationaha.org Circulation. 2003;107:645-651American Stroke Association: “Power Sunday Downloadable Toolkit” (for faith-based organizations), http://www.strokeassociation.org/presenter.jhtml?identifier=3046147
30 5/24/2023
Indicator 2PHYSICAL ACTIVITY IS PROMOTED
Physical activity areas and opportunities are designated, safe, accessible, and promoted throughout the city.
Why is this important?Physically active people have less risk for cardiovascular disease, high blood pressure, diabetes, and obesity among other chronic diseases. The 2008 Physical Activity Guidelines for Americans, published by the US Department of Health and Human Services recommends children and adolescents (6-17) obtain one hour or more of physical activity daily and adults (18-64) obtain two and one half hour per week of moderate physical activity or one hour and 15 minutes of vigorous physical activity per week. Vigorous physical activity by youth that results in sweating or breathing hard for 20 minutes per day on 3 or more days per week is considered by the CDC to be an indicator for preventing chronic disease.
The following six criteria are evidence-based strategies that use local policies and the built environment to encourage citizens to be more physically active on a daily basis.
A. There is strong evidence for creating and enhancing access to places for physical activity combined with informational outreach activities.
B. Urban planning, transportation, and infrastructure changes to promote physical activity are currently under review.
C-E. Community wide campaigns involving many community sectors in highly visible, broad based, multi-component approaches are strongly recommended for increasing physical activity.
F. Point of decision prompts, individually-adapted health behavior change, school and worksite based programs, and non-family social supports are also recommended for preventing and controlling chronic disease.
CRITERIA
A. Designated outdoor/indoor recreation areas exist in all or most areas of the city.
Indicate below how your community is meeting this criterion: Estimated mileage of: Walking and jogging trails Bike trails Estimated percent of community that is connected by sidewalks or trails (sidewalks or
walking trails are available for pedestrians wanting to walk from residential to commercial areas or to work or schools)
Estimated percent of community that is connected by bike trails (bike trails are available for riders wanting to ride from residential to commercial areas or to work or schools)
Number of community/neighborhood parks Total parkland acreage Total number of residents Park acreage/1,000 residents
Meets the Urban Land Institute standard of 25.5 acres of parkland per 1,000 residents Meets the National Recreation and Park Association (NRPA) "target of excellence" 6.25 to 10.5 acres of park land per 1,000 persons in urban areas.
Number of community recreation centers Number of other sites providing access to physical activity areas/equipment List sites: (These can include worksites, faith based sites, shopping malls, schools after hours, etc.)
Additional descriptions:
31 5/24/2023
B. City policies and planning/design components are in place for parks, walking and biking trails, urban areas, and recreational areas (indoor and outdoor) that include some measures and/or assessments of accessibility and safety.
Please check the boxes below to indicate how your community is meeting this criterion: Policies are in place for including sidewalks and biking trails in new developments Planning/design is in place to increase walking/biking/recreation space Safety and accessibility are part of policy and infrastructure considerations Goals for parkland acreage are included in city planning. City goal: acres per 1,000 population.
Include copies of all written policies and city planning documents that provide evidence that these things are in place.
Additional descriptions:
C. Physical activity is promoted through a variety of methods
Please check the boxes below to indicate how your community is meeting this criterion: The city has a map of the city’s walking/biking trails and recreational areas readily available to the public. Promotional campaigns are in place to encourage people to use walking trails, jogging trails, and bike
trails/ routes. Promotional campaigns are in place that encourage people to use outdoor/indoor recreation areas. The use of pedometers are promoted to encourage people to track and increase physical activity
levels.Include copies of maps and campaign materials when available. When not available, briefly describe campaigns.
Additional descriptions:
D. Recreational programs are available for all populations
Please check the boxes below to indicate how your community is meeting this criterion:Name of Program
Check if available at no cost
Check if serves children/teens
Check if serves adults
Check if serves older adults
Check if serves disabled/those with chronic disease
Programs can include private and public opportunities.
Additional description:
E. Physical activity is promoted year round and through special events such as Texas Roundup, Walk Texas, and other physical activity events.
Indicate how your community is meeting this criterion:Name of Event(s)
32 5/24/2023
Date(s) of events: Additional Descriptions:
F. Physical activity for community members with chronic disease and disability is available and accessible.
Please check the boxes below to indicate how your community is meeting this criterion: Places to be physically active are available, accessible, and incompliance with the Americans with
Disabilities Act (ADA) Warm water pools are accessible and offer the Arthritis Aquatics Program.
(http://www.arthritis.org/chapters/texas/programs.php ) Community recreation centers offer evidence-based physical activity or self-help intervention programs
for members with chronic diseaseDescribe:
Examples of meeting these criteria Development and promotion of walking trails Design components and policies can include: zoning regulations, building codes, and builders
practices, and city planning documents that include design elements for places to be active Adoption of a Complete Streets policy for new development or road upgrades Safety examples include: Improved street lighting, traffic calming efforts (speed bumps), and
enhanced street landscaping. Policies are in place for including sidewalks and parks in new developments City maps clearly identify walking/bike trails Special events can include Texas Round-Up and/or other events held within the past year. EnhanceFitness and the Arthritis Foundation Exercise Program
Resources/ReferencesGuide to Community Preventative Services: Systematic Reviews and Evidence-based Recommendations, U.S. Task Force on Community Preventive Services www.thecommunityguide.org AHA Guide to Improving Cardiovascular Health at the Community Level, American Heart Association www.circulationaha.org Circulation. 2003;107:645-651.Physical Activity for Everyone, http://www.cdc.gov/nccdphp/dnpa/physical/everyone/index.htm.Active Community Environments, http://www.cdc.gov/nccdphp/dnpa/physical/health_professionals/active_environments/index.htm Arthritis Foundation Aquatic/Exercise Programs www.arthritis.org , http://www.cdc.gov/arthritis/intervention/index.htm “Texas Round Up”,”FitKids”: http://www.texasroundup.org/ “GetFitTexas!”, Texas Advisory Council on Physical Fitness: http://www.governor.state.tx.us/organization/ “Walk Texas!”: http://www.dshs.state.tx.us/diabetes/walktx.shtm “Walk Across Texas”: http://walkacrosstexas.tamu.edu/ “Texercise”: http://www.texercise.com/ Texas Parks and Wildlife, “Life’s Better Outside”: www.tpwd.state.tx.us/exptexas National Society of Physical activity Practitioners in Public Health: http://www.nspapph.org Physical activity recommendations for Americans www.health.gov/paguidelines/factsheetprof.aspx. National Complete Streets Coalition http://www.completestreets.org/
33 5/24/2023
Indicator 3ACCESS TO HEALTHY FOOD
Healthy food options are accessible and promoted to all members of the community.
Why is this important?Overweight and obesity contribute to increased risk for cardiovascular disease and stroke. Incidence of overweight and obesity is on the rise. Over 65% of Texans were found to be overweight or obese in 2007.
The following five criteria are evidence-based strategies that use policies and elements in the community environment to make it easier for individuals living in the community to make healthy food choices.
A. Addressing good nutrition as part of a multi-component intervention aimed at nutrition, physical activity, and cognitive change is recommended. This can best be accomplished through a multi-sector, collaborative approach.
B. An increase in the quantity and accessibility of healthy food products can contribute toa wider adoption of good nutrition habits.
C. Point of purchase nutrition interventions in restaurants and supermarkets provide consumers with information, reminders, and reinforcements to guide them toward healthful food selections. Controlled studies in cafeterias, restaurants and supermarkets have demonstrated positive behavioral effects on the selection of “more nutritious” foods and on nutrition knowledge and attitudes.
D. Community level policies can have a significant impact on the adoption of protective health behaviors and are more likely to impact a greater number of residents in an equitable manner than individual health behavior change programs.
CRITERIA: A. A local, active coalition and/or food policy council works to establish policies and an environment that increase the availability of healthy food options for all residents and promotes healthy food choices.
Please check the boxes below to indicate how your community is meeting this criterion: There is a coalition/council/work group involved in promoting healthy food availability
Name of Coalition(s)/Council(s) promoting healthy food availability The appropriate organizations/sectors are involved in promoting healthy food availability (diabetes
groups, obesity groups, heart disease groups, nutritionists, school health staff, worksite wellness staff, food vendors/suppliers, restaurants, grocery stores)
Organizations/entities involved Please submit evidence of coalitions/councils/work groups such as meeting minutes, agendas, roster of members or description of work done in the past year.
Additional descriptions:
B. Community gardens, farmer’s markets, and outlets selling fresh produce are available and accessible by all members of the community.
Please complete the boxes below to indicate how your community is meeting this criterion: Number of community gardens Number of farmer’s markets Number of pick-your-own, roadside stands, and on-the-farm locations
(These are listed on picktexas.com through Texas Department of Agriculture.) Number of other farm direct programs
(Examples: National Farm to School, Sustainable Food Center, farm to work programs)
34 5/24/2023
Number of grocery stores selling fresh produce Fresh produce is available in all populated sectors of the city Bus services are available to/ from sites that sell fresh produce
Additional descriptions:
C. Restaurants, cafeterias, and other food establishments offer and/or label healthy options, which are promoted through a local dining guide or city website.
Indicate below how your community is meeting this criterion: Number of restaurants that include point of purchase labeling for healthy options (indicating no trans
fats, low fat, low-carb, low sodium and/or low sugar. A dining guide is available that identifies healthy food options in the area. Include a copy of the dining guide. The dining guide is available/accessible to everyone in the community
In hard copy format On the Internet: URL: The guide is written at an appropriate reading level (5-6 grade level), The dining guide is available in relevant languages The dining guide includes restaurants at different cost levels (ex: low cost, medium cost, high cost) The dining guide includes a variety of dining options (ex: fast food, take out, dine in) The dining guide includes nutrition information to assist in making healthy selections The dining guide is widely promoted within the community
A city or local health authority-endorsed recognition program exists to recognize restaurants that offer smaller portions and/or healthy options (for example – Mayor’s Fitness council)
Fruit and vegetables are included as part of “value meals” in place of traditional food items such as french fries and chips in some area restaurants.
In the majority of restaurants, calorie and other key nutritional information is provided for all menu items in a form that is easily available for consumers (ie: amount of fats, trans fats, cholesterol, sodium, sugar, carbohydrates, fiber, protein, etc)
Supermarkets promote healthy food choices by posting nutritional information at the point of purchase.
Additional descriptions:
D. City policies or ordinances address access to healthy foods and/or limit access to unhealthy foods for youth.
Please check the boxes below to indicate how your community is meeting this criterion: Zoning ordinances limit convenience or fast food outlets around schools Zoning ordinances or city planning efforts encourage neighborhood grocery stores Public transit routes consider access to supermarkets that offer fresh produce The city has a wellness or obesity prevention plan that considers access to healthy food options and promotes healthy eating
City wellness program and city policies promote healthy food choices for employeesAttach copies of wellness program statements and/or city policies
Additional descriptions:
Examples of meeting these criteria
City planning and zoning ordinances that allow fresh produce markets in residential areas Greater Houston Nutrition Coalition American Cancer Society Nutrition and Physical Activity Committee (NUPA) Live Well- Texas Women’s College Healthy Lubbock Coalition Farmers markets and community garden programs
35 5/24/2023
Farm to Work, Farm to School Programs Grocery stores with fresh produce that are accessible throughout the community that includes
underserved, low income, or priority populations
Resources/References
Texas Behavioral Risk Factor Surveillance Survey, 2007. Guide to Community Preventative Services: Systematic Reviews and Evidence-based Recommendations, U.S. Task Force on Community Preventive Services www.thecommunityguide.orgAHA Guide to Improving Cardiovascular Health at the Community Level, American Heart Association www.circulationaha.org Circulation. 2003;107:645-651.Dietary Guidelines for Americans 2005, http://www.health.gov/dietaryguidelines/Department of State Health Services Regional Nutritionist: http://www.dshs.state.tx.us/obesity/NPAOPregion.shtm“Pick Texas, Texas Certified Farmers Markets 2009”: http://www.picktexas.com/farm_market/farmers_market2.htmAgriLife Extension County Offices: http://texasextension.tamu.edu/county/“Healthy Dining”: http://www.healthydiningfinder.com
36 5/24/2023
Indicator 4HEALTHY SCHOOLS AND HEALTHY WORKSITES
Public schools comply with all legislated components of a coordinated school health program and daily physical activity and high schools offer an evidence-based health curriculum.
Worksites wellness programs are in place for the majority of employees.
SCHOOLS
Why is this Important?The following five criteria are evidence-based strategies for reducing childhood obesity and promoting habits that, if maintained for a life time will contribute to reduced cardiovascular disease. Several of the criteria are mandated by law for Texas schools. Schools for this indicator include public and private grades K-12.
A. All Texas school districts are required by law to implement a coordinated school health program in grades K-8. The Texas Education Agency makes coordinated school health programs and training for school districts available to elementary, middle, and junior high schools. Coordinated School Health (CSH) is a systemic approach of advancing student academic performance by promoting, practicing and coordinating school health education and services for the benefit and well-being of students in establishing healthy behaviors designed to last their lifetime. The eight components include health education, physical education, health services, nutrition services, counseling and psychological and social services, a healthy school environment, health promotion staff, and family/community involvement.
B. Physical activity/physical education is mandated by legislation for full day prekindergarten, elementary, middle, and junior high school students. The Texas Board of Education establishes guidelines for the amount of daily physical activity/physical education for each grade level.
C. Every independent school district is required by law to have a School Health Advisory Council (SHAC) with requirements for membership and meetings and recommendations for indicators of effectiveness. SHACs provide an efficient, effective structure for creating and implementing an age-appropriate, sequential health education program, and early intervention and prevention strategies that can easily be supported by local families and community stakeholders.
D. While school based interventions for promoting healthy eating are still under review, creating an environment in which healthy food choices are offered and access to unhealthy choices is limited provides parents with the assurance that, while at school, children have the opportunity to enjoy a healthy diet.
E. Schools are an excellent resource for community based physical activity. Schools offer sporting facilities, play grounds, recreation areas, and experts in physical education that can be made available to parents, children after school, and the community at large.
F. In 2007, the Education Code was amended to require each school district to have at least one AED at each campus, to annually provide training in CPR and AED use, to have an AED available during all UIL-Sanctioned athletic events and ensure a trained employee is available when a substantial number of students are present.
CRITERIA:
A. School districts are implementing a Texas Education Agency approved coordinated school health program and Texas Board of Education rules for daily physical activity.
Please complete the boxes below to indicate how your community is meeting this criterion: Number of school districts in the city Number of K-8 schools in the city Number of K-8 schools implementing a coordinated school health program Name of coordinated school health program(s)
37 5/24/2023
Number of staff trained to teach the program(s) Number of schools grades 9-12 in the city Number of schools grades 9-12 providing evidenced based health curricula Name of health programs taught in grades 9-12
Schools have designated Health and Physical Education Coordinators in place Schools are conducting tobacco use avoidance education (See Indicator #5)
Additional descriptions:
B. Schools are implementing daily physical activity requirements.
Please complete the boxes below to indicate how your community is meeting this criterion: Number of elementary, middle, and junior high schools in the city Number of these schools implementing required amount of daily physical activity Number of schools implementing Fitnessgram Average number of times students are evaluated in a school year Number of high schools in the city Number of high schools offering physical education classes
Additional descriptions:
C.School Health Advisory Councils (SHACs) are in place and active
Please complete the boxes below to indicate how your community is meeting this criterion: Number of SHAC’s in the city Average number of meetings held per year per SHAC Average number of parents involved per SHAC Average number of members per SHAC List examples of member’s professional and community affiliations (what sectors of the
community do they represent? For example: parents, doctors, nurses, lawyers, faith based, etc.)
Number of Healthier US awards given to schools in the city (data available at http://teamnutrition.usda.gov/HealthierUS/silvergoldtn.html.)
Additional descriptions:
D. Schools promote healthy food choices among the students and staff.
Please check the boxes below to indicate how your community is meeting this criterion: Nutrition topics are incorporated across the curricula Events are conducted involving parents and children that promote healthy eating Fresh fruit and vegetables are provided for students at breakfast and lunch and offered as a snack choice
where snacks are sold throughout the school day Policies are in place that require an adequate time period for students to eat school meals Point of decision prompts are provided at vending machines, cafeterias, and break rooms (i.e. signage,
flyers, taste tests that encourage healthy choices)
Additional descriptions:
E. Schools promote increased physical activity among the students and staff.
Please check the boxes below to indicate how your community is meeting this criterion: Physical activity topics are incorporated across the curricula. Events are conducted involving parents and children that promote physical activity.
38 5/24/2023
Safe Routes to School Program(s) are in place to allow safer walking and bicycling to and from school. School facilities are open outside of school hours for physical activity offered by the school and/or
community- based organizations Daily recess periods are provided for elementary students, featuring time for unstructured,
supervised play.
Additional descriptions:
F. Schools are following mandates for availability and use of AED’s
AED’s are located on all school campuses and available at UIL sanctioned sporting activities (See Indicator 7, Criterion B)
Examples of meeting these criteria Coordinated Approach To Child Health (CATCH) The Great Body Shop School Health Advisory Council 30 minutes of daily physical activity or 135 minutes per week “Bike and Hike School Program” (Silver Lake Elementary School, Grapevine, TX) FitKids (Texas Round Up) “Hoops for Heart”, “Jump Rope for Heart” (American Heart Association)
References/ResourcesSchool district lead nurse, lead physical education coachTexas Education Agency, Physical Fitness Assessment Initiative (PFAI): http://www.tea.state.tx.us/index3.aspx?id=2812Coordinated School Health Program, CDC, www.cdc.gov/healthyYouth/SCHPGuide to Community Preventative Services: Systematic Reviews and Evidence-based Recommendations, U.S. Task Force on Community Preventive Services www.thecommunityguide.org. School Health Program, Department of State Health Services, www.dshs.state.tx.us/schoolhealth/legisup.shtm. Title 2, Chapter 28, Section 28.004 of the Texas Education Code: www.capitol.state.tx.us/statutes/ed.toc.htm.Alliance for a Healthier Generation (Healthy School Programs): http://www.healthiergeneration.org/
WORKSITES
Why is this important?The following criteria are evidence-based strategies for promoting physical activity, healthy eating, and other health promoting behaviors at worksites. Worksites include public and private places of employment. A-B. Comprehensive multi sector programs include worksites and worksite wellness programs are
recommended strategies for promoting physical activity. Worksite programs to control overweight and obesity are recommended and can include educational, behavioral and social, and policy and environmental approaches to support behavior change.
C. Enhancing access to healthy foods at worksites is under review.D. Worksite wellness programs that combine assessment of health risks with feedback and other health
education is recommended.E. Smoke-free policies to reduce tobacco use among workers, including private-sector rules and public
sector regulations, is a recommended strategy that protects all workers from exposure to environmental tobacco smoke. Incentives and competitions to increase cessation can be effective when combined with other interventions.
39 5/24/2023
CRITERIA
A. Worksites are included in multi-sector campaigns promoting risk reduction and health promoting behaviors.
Worksites are included in community wide, multi-component campaigns (See Indicator 1.B) There is a person, organization, or coalition in the community working directly with employers to
promote/facilitate worksite wellness implementation. Name/org:
Additional descriptions:
At a minimum, the 5 largest (employ the most residents) worksites in the community have the following in place:
Worksite 1. Name -
2. Name -
3. Name -
4. Name -
5. Name -
Number of employeesB. Worksites provide access to places to be physically active and promote physical activity
for employees.Indoor and/or outdoor walking trails/ tracks are promoted for use before work, during breaks, and after work.A policy is in place that requires stairwells to be clean, attractive, and safe.Use of stairs is promoted by point of decision prompts (i.e. signage, flyers) at elevators, stairwells, in break rooms, etc. to encourage physical activity.Facilities such as showers, changing rooms, and bike racks are provided to encourage walking and/or bicycling to work.A policy is in place that allows employees flex-time or other work-schedule options to incorporate physical activity breaks into their day.Onsite wellness classes are available to educate employees about the importance of physical activity and other lifestyle factors in the prevention of chronic disease.Worksite events are held for employees and families that promote physical activity and other healthy lifestyle
40 5/24/2023
activities.C. Worksites promote healthy food choices among employees by establishing policies and
creating an environment that facilitates behavior change.Educational programs are available that promote healthy eating.Point of decision prompts are provided at vending machines, cafeterias and break rooms (i.e. signage, flyers, taste testing).Policies are in place that require vending machines and cafeterias to include and promote healthy food options.Policies are in place that require healthy food and beverage options to be available at all work sponsored events. Worksite events for employees and families have taken place that promote healthy food choices.D. Employee wellness programs are in place.An employee wellness program is in placeA staff person is designated to coordinate the wellness programA health risk assessment is used with feedback and educationValue-based benefits design is used in negotiating health benefits that promote primary and secondary prevention practices among employeesAutomated external defibrillators are availableWorksite has established first responders for emergenciesWorksite makes CPR training available to employeesNumber of employees trained to use AEDs
A policy is in place for AED maintenanceE. Worksites are smoke-free and promote tobacco avoidance and tobacco cessation as part of
an employee wellness program.Tobacco cessation is offered and promoted
41 5/24/2023
Worksites are tobacco-free
Additional descriptions:
If the City and local Independent School Districts are not listed among the top 5 worksites, please indicate how these worksites are meeting these criteria:
Worksite employee wellness programs are provided for local ISD employees All ISDs in the city At least 50% of ISDs Less than 50% of ISDs
A worksite employee wellness program is in place and promoted for city employees.
Additional descriptions:
Examples of meeting these criteria Worksite Wellness examples can include: The Wellness Programs and Community Planning Models
as made available through the DSHS Cardiovascular Health and Wellness Program. Start- Fit Friendly Company Weight Watchers Meeting at Work Building Healthy Texans programs and resources http://www.wellness.state.tx.us/
References/ResourcesHealthier Worksite Initiative at http://www.cdc.gov/nccdphp/dnpa/hwi/index.htm Guide to Community Preventive Services: Systematic Reviews and Evidence-based Recommendations, U.S. Task Force on Community Preventive Services www.thecommunityguide.org. “Successful Business Strategies to Prevent Heart Disease and Stroke Toolkit” (CDC): http://www.cdc.gov/library/toolkit/index.htm
42 5/24/2023
Indicator 5COMPREHENSIVE TOBACCO CONTROL
A comprehensive tobacco control program is in place that includes a 100 % smoke free city smoking ordinance.
Why is this important?Tobacco use is the single largest cause of preventable premature death in the United States and exposure to environmental tobacco smoke (ETS) is a preventable cause of significant illness and death. Policies to reduce smoking indoors reduces exposure to ETS; they can also result in both a reduction in the number of cigarettes smoked each day and an increase in the number of smokers who quit. Tobacco use is a cause of heart disease and stroke and can increase blood pressure. Exposure to second hand smoke can increase risk for heart attack by 25-35%. Smoke free policies can increase both the number of people who try to quit and the number of attempts made by each person. Smoke free policies also challenge the perception of smoking as a normal behavior. This can influence how adolescents view smoking, resulting in reduced smoking rates in youth.
The following four criteria are evidence based strategies for implementing a community-wide, comprehensive tobacco control program.
A. Establishing and enforcing a city-wide, 100% smoke free ordinance will establish social norms and will eliminate exposure to secondhand smoke. Studies that evaluated the effect of smoking bans in workplaces observed an average reduction in exposure to components of ETS (e.g., nicotine vapor) of 72%. Smoking bans were more effective in reducing ETS exposures than were smoking restrictions. Smoking bans were effective in a wide variety of public and private workplaces and healthcare settings. Their effectiveness should extend to most indoor workplaces in the United States. Studies evaluating smoking bans also observed reductions in the amount smoked
B. Preventing initiation that focus on youth and young adults through local coalitions and programs including school-based youth and parent programs
C. Promoting quitting among adults and youth through public awareness campaigns in tobacco use cessation and nicotine addiction treatment
D. Identifying tobacco-related disparities among population groups will target diverse and priority populations such as minorities, persons in rural areas, and youth alternative settings.
Source: Guide to Community Preventive Services: Systematic Reviews and Evidence-based Recommendations, U.S. Task Force on Community Preventive Services www.thecommunityguide.org.
43 5/24/2023
CRITERIA:
A. The city has a 100% Smoke Free ordinance that covers all public and private worksites.
To determine if your city meets this criterion, the council will consult the DSHS/University of Houston database at http://txshsord.coe.uh.edu/.
5 - Strong 4 – Moderate 3 - Average 2 - Fair 1 – PoorMunicipal worksitesPrivate sector worksites (includes bingo and bowling halls that are not covered under bars and restaurantsRestaurantsBars in restaurantsBars not in restaurantsPenalties are in place for business violationsPenalties are in place for smoker violationsTotal
Average score:
Key to Score:5- 100% Smoke Free- No smoking allowed in a particular setting. Both fines and criminal charges are in place for violations.4- Moderate- Designated smoking areas are allowed if separately ventilated. The owner or manager may choose to be smoke free or designate separately or independently ventilated smoking areas.3- Mixed- Either no smoking is allowed OR designated smoking areas are allowed if separately or independently ventilated, but coverage is partial due to exceptions, ambiguities, or legal issues. Either fines or criminal charges are in place for violations. 2- Limited- Designated smoking areas allowed or required.1- No coverage- No restrictions on smoking in the stated setting. No penalties are in place for violations.
Comments:
B. The city is preventing initiation of tobacco use among youth and young adults through local coalitions and school-based youth and parent programs.
Please check the boxes below to indicate how your community is meeting this criterion: There is a coalition/council/work group involved in preventing initiation use of tobacco use in adolescents
and young adults. Name of coalitions(s)/council(s)/work group(s) involved in tobacco control :
Please submit evidence that the coalition/council/work group is active such as a plan, meeting minutes, agenda, roster of members, or description of work done in the past year (submit any or all).
Schools are using an approved program for preventing the initiation of tobacco use among youth and young adults
Name of school-based program
Additional descriptions:
44 5/24/2023
C. The city is promoting quitting among adults and youth through public awareness campaigns such as tobacco use cessation and nicotine addiction treatment services are in place.
Please check the boxes below to indicate how your community is meeting this criterion: There is a tobacco cessation education through the use of media
Television Newspaper Billboards Radio
The campaign is locally developed or nationally recognized. Name of campaign: There is a tobacco cessation quit line promoted and available that has the potential to reach large
numbers of tobacco users. Name of Program:
This is a national or state supported program This is a locally supported program. Organization supporting the program:
Tobacco users are offered counseling services and FDA-approved cessation medications at health sites or through health plans.
Additional descriptions:
D. The city is identifying tobacco-related disparities among population groups and targeting diverse and priority populations such as minorities, persons in rural areas, and youth in setting other than schools.
Please check the boxes below to indicate how your community is meeting this criterion: Disparities among local population groups have been identified. Disparate population groups are targeted for prevention and cessation efforts. Services are available in formats that meet the language and cultural needs of the following groups: Hispanics African Americans Asians Native Americans Rural Youth in settings other
than schools College studentsPlease describe how disparate population groups are receiving prevention and cessation services:
Examples of meeting these criteriaFor examples of smoking ordinances adopted by other Texas communities, visit http://txshsord.coe.uh.edu/ .
Youth programs that promote tobacco avoidance: Coordinated Approach To Child Health (CATCH) The Great Body Shop Mi Familia No Fuma Be Free Indeed The Life Skills Toward No Tobacco (TNT) curriculum
Resources/ReferencesDepartment of State Health Services Regional Tobacco Control Coordinator: http://www.dshs.state.tx.us/tobacco/regions.shtm “Community Tobacco Prevention and Control Toolkit”: http://www.dshs.state.tx.us/tobacco/bestpractices/default.shtm “A Clinical Toolkit for Treating Tobacco Dependence”: http://www.dshs.state.tx.us/tobacco/toolkit.shtm Best Practices for Comprehensive Tobacco Control Programs, October 2007, Centers for Disease Control and PreventionWorld Health Organization International Agency for Research on Cancer Monographs on the Evaluation of Carcinogenic Risks to Humans, Volume 83: Tobacco Smoke and Involuntary Smoking, July 2002.Guide to Community Preventative Services: Systematic Reviews and Evidence-based Recommendations, U.S. Task Force on Community Preventive Services www.thecommunityguide.org.
45 5/24/2023
CDC Smoking and Tobacco Control at http://www.cdc.gov/tobacco/.
46 5/24/2023
Indicator 6ADDRESSING DISPARITIES
A plan is in place to reduce disparities in CVD and stroke.
Why is this important?National and state CVD and stroke statistics demonstrate major disparities in the burden of heart disease and stroke and their risk factors among different racial and ethnic groups, with striking disparities in the excess morbidity and mortality among African Americans (for both women and men) compared with all other groups. Disparities exist in terms of prevalence of hypertension and obesity, and death rates from heart disease and stroke.
The burden of disease rests most heavily on those Texans without health care coverage. Texas has one of the highest rates of uninsured in the nation. Many Texans with insurance are underinsured or cannot afford costs associated with co-pays and deductibles.
The following three criteria are evidence based strategies for addressing community wide issues, including disparities in health and quality of life.
A. Working to address the health care needs of disparate populations requires the concerted effort of all stakeholders in the community, including health care professionals, business leaders, health insurance providers, and local elected officials. Including representation from the populations at risk will ensure accurate, practical, and culturally appropriate programs and solutions are implemented.
B. The first step in preparing to address a community level problem requires a through understanding of the problem. Communities should conduct an assessment that may include collecting demographic, socioeconomic, environmental, and behavioral data about the community, its residents, and it resources.
C. Once an assessment has identified resources, opportunities, and gaps, a written plan will provide a logical process for addressing issues. Effective plans include critical steps or activities, a time line, responsible parties, and indicators to be measured to quantify success in reaching intended outcomes.
CRITERIA:
A. A community coalition/collaborative/group has been coordinated and is involved in assessing, planning, and implementing the community plan for reducing disparities in CVD and stroke.
Please check the boxes below to indicate how your community is meeting this criterion: A community coalition is in place to address CVD and stroke disparities
Name of coalition List member organizations
Underserved populations are represented on the coalition/groupList populations represented
Please provide a copy of one agenda/minutes from a meeting of the coalition/group.
Additional descriptions:
B: A community assessment has taken place that identifies the gaps in prevention and treatment of primary and secondary risk factors for CVD and stroke; gaps in access to treatment for CVD and stroke; and gaps in access to follow-up/long term care for underserved populations.
Please check the boxes below to indicate how your community is meeting this criterion: An assessment has taken place that identifies gaps in primary and secondary prevention services An assessment has taken place that identifies gaps in access to care for CVD and stroke patients
47 5/24/2023
An assessment has taken place that identifies gaps in access to follow-up and long term care for CVD and stroke patients
Underserved populations have been identified and include: Please provide a copy of all related assessments conducted within the past 5 years.
Additional descriptions:
C. The community has a plan in place for reducing the disparities in risk and morbidity and mortality from to CVD and stroke. Please check the boxes below to indicate how your community is meeting this criterion:
A written plan has been developed to address health disparities. Please submit a copy of the plan.
The plan to address disparities shows evidence of inclusion/participation by the populations identified as underserved.Evidence may include demonstration of planning that includes members of underserved populations or information/data was gathered from members of underserved populations.
Plan to address disparities was created or updated within the past 12 months.Date plan was created or last updated:
Plan includes coordination of services between organizations, including city and county level health sites to optimize reach and coverage within the community.
The plan has been shared with local policymakers. Please identify policymakers receiving the plan:
Additional descriptions:
Examples of meeting these criteria African American / Hispanic Task Forces are in place Diabetes Coalition is working on disparities American Heart Association materials are used: Search Your Heart/Conozca Su Corazon, Power to
End Stroke
Resources/ ReferencesDepartment of State Health Service, Public Health Improvements Regional Coordinator: http://www.dshs.state.tx.us/regions/default.shtm Office for the Elimination of Health Disparities: http://www.hhs.state.tx.us/oehd/index.shtml Burden Report, Cardiovascular Health and Wellness Program, Department of State Health Services. www.dshs.state.tx.us/wellness/data.shtm. A Public Health Action Plan to Prevent Heart Disease and Stroke, Department of Health and Human Services, 2003.For the Burden of Disease for CVD and Stroke for Texas or your community visit: http://www.dshs.state.tx.us/wellness/data.shtmAmerican Heart Association, Cultural Health Initiatives: http://www.americanheart.org/presenter.jhtml?identifier=3029584
48 5/24/2023
Indicator 7BYSTANDER CPR AND AED USE
Training programs are in place to improve the rate of bystander CPR and use of AEDs.
Why is this important?Seconds count when a cardiac arrest occurs. Because most cardiac arrests happen outside of the hospital setting, bystander response to an event is critical. Laypersons are most likely to arrive first at the scene of an arrest and chances are they will know the victim. In 75 to 80 percent of cases, sudden cardiac arrest occurs in the home. Another 10 to 15 percent of cases occur in the workplace.
The following five criteria are evidence based strategies for reducing mortality from out of hospital cardiac emergencies.
A-D. Early CPR increases the likelihood that early defibrillation will work. In fact, the likelihood of survival doubles if a bystander begins CPR before the EMS team arrives.Increasingly, researchers are finding that the quality of CPR has a major impact on the likelihood of survival. They have found it is important to provide strong, forceful compressions and to minimize interruptions in compressions.
B. All communities can aim to reduce the critical interval from collapse to defibrillation, particularly with on-site AED programs. Since the exact time of collapse often is difficult to identify and measure, communities can focus on minimizing the interval from the 9-1-1 call to the first defibrillatory shock and onset of CPR. Communities that reduce this “call-to-shock” time to five minutes or less can expect as many as one-third to one-half of sudden cardiac arrest victims found in ventricular fibrillation to be resuscitated. Reducing “call-to-shock” time by even one minute can mean the difference between life and death.
Children as well as adults may suffer life-threatening emergencies, so having AED’s and trained personnel in schools is important. In 2007, the Education Code was amended to require each school district to have at least one AED at each campus, to annually provide training in CPR and AED use, to have an AED available during all UIL-Sanctioned athletic events and ensure a trained employee is available when a substantial number of students are present. Equipping all sites that routinely attract large numbers of people with AEDs will ensure a device is available in the event of an emergency, reduce time from onset of attack until defibrillation, and increase survival from cardiac events.
E. Eliminating disparities in sudden cardiac death includes indentifying areas where the incidence of sudden cardiac arrest is greatest in the community and targeting CPR training to persons living or working in these geographic or residential areas. Many communities have high numbers of people trained in CPR and AED use, but they are largely residents of more affluent neighborhoods.
F. Bystanders who recognize the symptoms of cardiac arrest and act promptly to phone 9-1-1 and begin CPR could save many of the 250,000 lives lost to cardiac arrest. Early recognition of signs and symptoms and early intervention with CPR/AED and emergency services is critical to saving lives.
CRITERIA:
A. Nationally recognized training programs are in place for CPR and AED classes
Indicate below how your community is meeting this criterion:49 5/24/2023
Nationally recognized CPR/AED training programs are available to the community.Identify which programs are available
Number of CPR/AED trainings held in the community in the past year Total number of people trained in CPR/AED in the past year
Additional descriptions:
B. AED’s are available throughout the community
Please complete the boxes below to indicate how your community is meeting this criterion:AEDs are available on all public school campuses
List all Public School Campuses # AEDs available # People Trained to Use AEDs
AED’s are available in the following locations throughout the community (check all that apply): Site AEDs are available A policy is in place for
AED maintenanceNo sites in
cityAthletic, UIL (University Interscholastic League)-Sanctioned ActivitiesMajor public transportation terminalsRecreational facilities (public and private, ex: swimming pools, rec centers)Professional sports venues (ex: ball fields, expo centers, stadiums)Five largest worksites See Indicator 4
Criteria DState government office buildingsCity government office buildingsCounty government office buildingsJails/detention centersFaith Based facilities with large congregationsEntertainment venues (theaters, etc)
Additional descriptions:
50 5/24/2023
C. Emergency Medical Services effectively documents whether bystander CPR and use of an AED is in progress upon arrival at the scene of a cardiac arrest.
Please check the boxes below to indicate how your community is meeting this criterion: EMS services track the incidence/rate of bystander CPR (CPR performed prior to arrival of designated
Emergency Responders). Rate of bystander CPR in the past 12 months
EMS services track the incidence of bystander AED use Rate of bystander AED use in the past 12 months
Additional descriptions:
D. The community’s Emergency Medical Dispatch System provides 911 callers with prompt and effective CPR instructions at the scenes of a cardiac arrest.
Please check the boxes below to indicate how your community is meeting this criterion: EMS Dispatchers provide 911 callers with CPR instruction when appropriate.
Please submit a copy of the dispatch protocols related to provision of CPR instruction.
Additional descriptions:
E. The community has a mechanism for identifying underserved or areas of focus with regard to CPR training needs.
Please check the boxes below to indicate how your community is meeting this criterion: The community has a mechanism for identifying underserved or areas of focus with regard to CPR
training needs. Briefly describe: The community has taken action to address the need for CPR training in areas with highest need. Briefly
describe:
F. Public awareness programs are in place to educate the public about the signs and symptoms of heart attack and the importance of calling 911, Please check the boxes below to indicate how your community is meeting this criterion:
Public awareness programs are in place to educate the public about the signs and symptoms of heart attack and the importance of calling 911.
Name of program(s) Number of times programs have been available in the past year
Additional descriptions:
Examples of meeting these criteria American Heart Association programs are used American Red Cross programs are used Organizations providing CPR certification are tracking where classes are taught – data is evaluated
to ensure all areas of community have access to classes Local EMS providers include provision of bystander CPR and use of AED as check off on patient
documentation records, data is collected and assessed as a quality indicator for the community
Resources/ReferencesAmerican Heart Association, www.americanheart.org, “CPR ANYTIME for Friends and Family”Community CPR-AED Programs. Sudden Cardiac Arrest Foundation athttp://www.sca-aware.org/community-aed-programs.php
51 5/24/2023
Indicator 8CARDIAC EVENT RESPONSE
Defibrillators (Manual and/or Automated External) are available to first responders and the emergency system of care maintains a rapid response time for cardiac events.
Why is this important? EMS is a critical part of the system of care for victims of heart attack and cardiac arrest. The following three criteria are evidence based strategies for ensuring an environment that is equipped and personnel that are trained to respond rapidly to a cardiac emergency. A. After a cardiac arrest, time until defibrillation is critical. Communities can aim to reduce the critical
interval from collapse to defibrillation by training and equipping all first responders (EMS/police/fire) to use CPR/AEDs and maintaining a rapid response time from 911 call to arrival on the scene of a CPR trained provider with a defibrillator.
B. Healthy People 2010 sets targets for the time interval between a 911 call and arrival at the scene at less than 5 minutes for first responders in urban areas. In rural areas, the targeted interval from the time a call is place to arrival on the scene is less than 10 minutes.
C. The availability and use of 12 lead ECG’s on ALS EMS vehicles can be a critical link in the system of survival for patients experiencing a myocardial infarction. Emergency Centers (EC) that can receive 12 lead ECG information on incoming patients can be prepared to take immediate and appropriate action when the patient arrives at the EC.
CRITERIA: A. Emergency personnel response units are adequately equipped with defibrillators
Please check the boxes below to indicate how your community is meeting this criterion: 100% of EMS transport vehicles are equipped with defibrillators that are of a design appropriate for
the level of training of personnel on each unit. Medical first response vehicles (ex: fire department vehicles) are equipped with AED’s Police and Sheriff’s Department vehicles acting as medical first responders are equipped with AED’s
Additional descriptions:
B. EMS system serving the city maintains a mean call to scene response time of 5-minutes or less in urban areas and 10 minutes or less in rural areas for a CPR/AED capable emergency responder to arrive at the scene of a cardiac arrest.
Please check the boxes below to indicate how your community is meeting this criterion:Mean response time for cardiac arrest for the past 12 months Mean response time = average of all calls from time call received until time CPR/AED capable emergency responder arrived on scene.EMS responders are covering regions that are considered (check all that apply):
Urban Suburban Rural
Additional descriptions:
52
C. The EMS System (Prehospital to Emergency Center) is equipped to manage patients with ST elevation myocardial infarction (STEMI)
Please check the boxes below to indicate how your community is meeting this criterion: Advanced Life Support capable EMS vehicles are equipped with 12 lead ECG’s. % of ALS capable vehicles with 12 lead .
The EMS System measures the proportion of STEMI patients who receive a prehospital 12 lead ECG. % of STEMI patients who receive a prehospital 12 lead ECG:
Resources/ReferencesDSHS Regional EMS Field Offices: http://www.dshs.state.tx.us/emstraumasystems/regions.shtm Trauma Service Area-Regional Advisory Council (RAC): http://www.dshs.state.tx.us/emstraumasystems/RACOpGuidelines.shtm Governor’s EMS & Trauma Advisory Council (GETAC): http://www.dshs.state.tx.us/emstraumasystems/governor.shtm American Heart Association, www.americanheart.org Mission Lifeline program
53
Indicator 9STROKE EVENT RESPONSE
Stroke is treated as a medical emergency in the community and appropriate acute stroke treatment protocols are in place.
Why is this important?Stroke is the third leading cause of death in Texas and in the nation. Stroke is a leading cause of serious, long-term disability and a major economic burden in terms of health care cost and lost productivity. Stroke is preventable and, when treated rapidly, disability can be prevented or minimized.
There is an urgent need for improvement in the medical infrastructure in Texas for the rapid diagnosis and treatment of stroke patients. The following are six evidence based strategies for improving the stroke system of care.
A. Regional Advisory Councils (RACs) have been established throughout Texas to address local issues related to the emergency services system. RACs have been directed to develop stroke committees to develop and oversee region specific stroke transport protocols. It is critical for city EMS personnel to participate in the planning and implementation of stroke protocols that meet the needs of each community.
B, C and E. Stroke is a medical emergency and should be treated as such within the EMS system of care. Prioritizing stroke at the highest level of response and maintaining rapid call to delivery times will ensure citizens receive the best care available.
D. An effective stroke system of care should ensure that hospitals are available and identified as "acute stroke capable", possess the appropriate resources, and deliver primary stroke care in accordance with national recommendations and local or national certifying bodies.
F. The public should be able to identify the signs and symptoms of stroke and know to call 911 immediately. Studies have demonstrated that communities with public education campaigns that include mass media and emergency personnel education can improve the time between onset of symptoms and hospital arrival. Because a large proportion of stroke victims have significant communication, motor, and cognitive deficits, each of which can dramatically delay onset of medical care, public education aimed at witnesses, especially family members and caregivers of persons at highest risk, about signs and symptoms and immediate call to 911 can reduce prehospital delays.
CRITERIA:
A. City EMS providers are participating with their Regional Advisory Councils to create a strong system of care for stroke victims.
Indicate below how your community is meeting this criterion: City EMS (911 responders) regularly attend RAC meetings RAC is working to advance the stroke system of care for the community
Additional descriptions:
B. The EMS system dispatch protocol prioritizes potential strokes at the highest dispatch level possible.
54
Please check the boxes below to indicate how your community is meeting this criterion: EMS protocols specifically prioritize suspected stroke at the highest dispatch level. All calls are considered highest priority (stroke is not prioritized above other calls)
Additional descriptions:
C. The EMS system has a specific stroke protocol that utilizes an appropriate assessment tool or scale, emphasizes minimizing call to scene time and rapid transfer to an appropriate facility.
Please check the boxes below to indicate how your community is meeting this criterion: EMS has a stroke protocol emphasizing appropriate assessment and rapid transfer
Please attach or insert a copy of the stroke protocol.
Additional descriptions:
D. The area is serviced by hospitals that meet the Brain Attack Coalition/JCAHO recommendations for primary stroke centers.
Please complete the boxes below to indicate how your community is meeting this criterion: Number of hospitals that meet the criteria of a primary stroke center Percent of residents covered by all primary stroke facilities (ie within a 14 minute transport
distance from facilities) Number of hospitals that meet criteria for a comprehensive stroke center Number of hospitals that meet criteria for stroke support centers
Additional descriptions:
E. EMS system serving the city maintains a 14-minute mean transport time for stroke emergencies.
Please complete the boxes below to indicate how your community is meeting this criterion: Mean transport time for stroke emergencies: Mean transport time = average of all calls from time EMS departed scene until time EMS arrived
at destination. EMS responders are covering regions that are considered (check all that apply):
Urban Suburban Rural
Additional descriptions:
F. Education is available to the public on stroke signs and symptoms and the importance of calling 911.
Please check the boxes below to indicate how your community is meeting this criterion: Public awareness programs are in place to educate the public about the signs and symptoms of
stroke and the importance of calling 911.Name of program(s) Number of times programs have been available in the past year
Program includes use of mass media (radio, TV, newspaper, billboards) Program includes distribution of educational materials (in print, electronically, through
newsletters, etc)Please provide evidence of campaign (copies of materials, run times in media)
Additional descriptions:
Examples of meeting these criteriaUse of FAST, Suddens, or Give Me 5 to educate about stroke signs and symptoms
References/ResourcesDSHS Regional EMS Field Offices: http://www.dshs.state.tx.us/emstraumasystems/regions.shtm Trauma Service Area-Regional Advisory Council (RAC): http://www.dshs.state.tx.us/emstraumasystems/RACOpGuidelines.shtm Primary Stroke Centers in Texas: http://www.qualitycheck.org Search “By State”, scroll down to “TEXAS”, then under “Service Type” scroll down to “Stroke (Primary Stroke Center” Governor’s EMS & Trauma Advisory Council (GETAC): http://www.dshs.state.tx.us/emstraumasystems/governor.shtm Brain Attack Coalition, http://www.stroke-site.org . American Stroke Association, http://www.strokeassociation.org. Reducing Delay in Seeking Treatment by Patients with Acute Coronary Syndrome and Stroke, Moser, Kimble et al. www.circulationaha.org Texas Stroke Initiative, http://www.dshs.state.tx.us/wellness/stroke.shtm.Acute Stroke Treatment Toolbox, http://www.strokeassociation.org/presenter.jhtml?identifier=2723. American Stroke Association: “Power Sunday Downloadable Toolkit” (Faith-based organizations), http://www.strokeassociation.org/presenter.jhtml?identifier=3046147 Joint Commission Primary Stroke Center Certification http://www.jointcommission.org/CertificationPrograms/PrimaryStrokeCenters /
56
Indicator 10HEALTH CARE QUALITY
Health Care Sites in the Community Promote Primary and Secondary Prevention of CVD and Stroke.
Why is this important?The following three criteria are evidence based strategies for improving prevention and control of CVD and related risk factors that recognize health care sites as sources for patient education, screening, and quality care. Health care sites include community clinics, hospitals, physician offices, group practices, rehabilitation facilities, etc. (Any site where health care services are offered).
A. It is well documented that primary prevention measures that include modification of unhealthy behaviors can lead to reductions in prevalence and mortality of chronic disease, including CVD and stroke. Primary prevention measures prescribed by health care professionals have been shown to have a positive impact on patient adoption of healthy behaviors. Practice of primary prevention can reduce health care cost.
B. Secondary prevention measures for CVD and stroke include diagnosing and controlling medical risk factors such as high blood pressure, high blood cholesterol, diabetes, overweight and obesity, and tobacco use. It is critical for health care providers to follow recommended guidelines for screening, diagnosis, and treatment of medical risk factors.
C. Participation in nationally recognized quality improvement programs that include monitoring, assessing, and improving practices related to CVD and stroke prevention and treatment
CRITERIA:
A. Health care sites conduct on-going programs and activities for primary prevention of CVD and stroke.
Please complete the boxes below to indicate how your community is meeting this criterion. Include major providers of services in the community:Health care sites conduct on-site programs and activities that educate clients and the public about CVD and stroke and promote healthy lifestyle behaviors in both well and at risk clients. Under each category briefly describe the program. Health care organization Stroke Heart
diseaseHigh blood pressure
High cholesterol
Diabetes
Please submit copies of program materials when available.
Health care sites conduct off-site programs and activities that educate clients and the public about
57
CVD and stroke and promote healthy lifestyle behaviors in both well and at risk clients. Under each category briefly describe the program. Health care organization Stroke Heart
diseaseHigh blood pressure
High cholesterol
Diabetes
Please submit copies of program materials when available.
B. Health care sites provide and/or prescribe services that meet or exceed general standards of care for secondary prevention of CVD and stroke.
Please complete the boxes below to indicate how your community is meeting this criterion. Include major providers:
Major Healthcare Organizations
Use clinical guidelines for screening servicesBehavior counselingBlood pressure managementLipid management,Weight managementTobacco cessationDiabetes managementAnticoagulation managementMedication adherenceAccess to medication and services for low-income patientsCardiac rehabilitationStroke rehabilitationOther: Please describe: Please submit copies of program materials when available.C. Health care sites participate in nationally recognized, quality improvement programs for secondary prevention and treatment of CVD and stroke.Health sites have implemented a quality improvement program List programs used Programs incorporate a system's change approachPrograms monitor treatment practicesPrograms conduct periodic and on-going data
58
collectionPrograms make appropriate system's adjustments based upon data analysis.Describe notable quality improvement that has taken place in the area of CVD, stroke, and related risk factors
Number of not for profit acute care hospitals in city Number of for profit acute care hospitals in city Number of Federally Qualified Health Centers in city (To find local FQHCs go to
http://www.dshs.state.tx.us/chpr/FQHCmain.shtm) Number of DSHS Primary Care funded sites in city Number of other community health centers in city Other health care sites not included above
Additional descriptions:
Examples of meeting these criteria Educational sessions at schools, community centers, other public gathering places. Screenings and referrals done on or off site Risk factor management programs Counseling or educational sessions on nutrition, physical activity, smoking cessation, tobacco
cessation, diabetes management, weight management, healthy coping etc American Heart Association – “Get With the Guidelines”
Resources/ReferencesInstitute for Healthcare Improvement at http://www.ihi.org/ihi. The Commonwealth Fund at http://www.commonwealthfund.org/programs/programs_list.htm?attrib_id=9132. Medicare Quality Improvement Program http://www.cms.hhs.gov/QualityImprovementOrgs/02_ResourcesforQualityImprovement.asp#TopOfPage. “Get with The Guidelines” from the American Heart Association: http://www.americanheart.org/presenter.jhtml?identifier=1165 “Guidelines Applied to Practice” from the American College of Cardiology:http://www.acc.org/qualityandscience/gap/gap_program.htm “Get With the Guidelines” for Stroke at http://www.strokeassociation.org/presenter.jhtml?identifier=3002728. List of hospitals that have earned a Performance Award in using “Get With The Guidelines” (American Heart Association and American Stroke Association): http://www.americanheart.org/presenter.jhtml?identifier=3039581 Mission: Lifeline TM is a national, community-based initiative created by the American Heart Association to improve systems of care for heart attack patients including those with ST-elevation myocardial infarction (STEMI).http://www.americanheart.org/presenter.jhtml?identifier=3050213
59
